Orthokeratology (OK) is the use of reverse geometry GP lenses primarily to temporarily correct myopia and low astigmatism. However, there are other forms of OK that can be considered when "conventional" OK is not appropriate. Toric OK lenses that can better align with moderately astigmatic corneas may provide better centration and more effective correction of astigmatism. Hyperopic OK lenses are designed to steepen the central cornea via a base curve that is steeper than the central cornea. A reverse geometry design is still needed, but the resulting "bull's eye" pattern has central clearance.

In addition, soft lenses are being investigated for myopic OK. The use of inverted high minus powered Air Optix Night & Day lenses to correct low myopia has been reported.¹ Though they were able to correct up to -1.75 D of myopia, they found the results to be variable, and central islands would often form. An abstract from the 2010 British Contact Lens Association Annual Conference reported on an investigative soft OK design that can flatten the cornea by up to 3.50 D, but again, central islands were common.²

Alternative modes of OK, including soft lens options, can expand your corneal reshaping patient base.

1. Caroline P, Andre M. Lessons in Soft Orthokeratology. CL Spectrum. 2010 Aug
2. Conrad F, et al. The biomechanical principles and potential value of soft contact lens orthokeratology. Contact Lens Anterior Eye 2010; 33(6): 259.

Acanthamoeba keratitis is still a threat to our contact lens wearers. A review of three case series published in 2010 highlights some of the nuances, clinical presentations, and associations with Acanthamoeba keratitis.

Between 2006 and 2009 in a single medical center in Saitama, Japan, 9 cases of Acanthamoeba keratitis were treated.¹ These nine patients were all soft contact lens wearers and all patients occasionally wore their lenses for longer than recommended. For example one patient was a daily disposable lens wearer who admitted to using their lenses for 2-3 days at a time. Additionally all patients also washed their lens storage cases with tap water.

Between January 2000 and December 2008 at the Massachusetts Eye and Ear Infirmary, 30 cases of Acanthamoeba keratitis were identified.² Four cases were identified between January 2000 and December 2003, whereas 26 cases were identified between January 2004 and December 2008. In a sample of their patients with longer follow-up, possible risk factors for Acanthamoeba keratitis included soft contact lens wear (12 of 15 cases) and exposure to freshwater or saltwater sources (8 of 15 cases). They concluded that the number of Acanthamoeba keratitis cases at the Massachusetts Eye and Ear Infirmary had increased since 2004.

In Cleveland, a retrospective review of records of all patients suspected of having Acanthamoeba keratitis from January 1999 through May 2008 was conducted at the Cole Eye Institute.³ Twenty-nine eyes of 26 patients were identified as having either culture- or tissue-proven Acanthamoeba keratitis. The most common risk factors identified were history of contact lens wear (89.7%) and exposure to contaminated water (27.6%). However, over the nearly 10-year period, there was no significant increase in the number of cases seen each year at that facility.

Therefore, these case series painfully remind us that Acanthamoeba keratitis continues to plaque contact lens wearers, and some centers are continuing to see increasing numbers of patients. The most common risk factor for Acanthamoeba keratitis continues to be contact lens wear and water exposure.

1. Mutoh T, Ishikawa I, Matsumoto Y, Chikuda M. A retrospective study of nine cases of Acanthamoeba keratitis. Clin Ophthalmol. 2010 Oct 21;4:1189-92.
2. Tanhehco T, Colby K. The clinical experience of Acanthamoeba keratitis at a tertiary care eye hospital. Cornea. 2010 Sep;29(9):1005-10.
3. Qian Y, Meisler DM, Langston RH, Jeng BH. Clinical experience with Acanthamoeba keratitis at the Cole Eye Institute, 1999-2008. Cornea. 2010 Sep;29(9):1016-21.

B+L Announces Global Licensing Agreement with UltraVision CLPL to Market KeraSoft Contact Lenses

Bausch + Lomb (B+L) announced a global licensing agreement with U.K.-based UltraVision CLPL to market and sell KeraSoft soft contact lenses throughout the world, through the network of B+L lab channel partners. KeraSoft patented technology allows for custom-made contact lenses for irregular corneas and keratoconus. As part of the agreement, B+L acquired the KeraSoft trademark. The announcement was made at the Global Specialty Lens Symposium in Las Vegas. The global roll-out of KeraSoft lenses will begin later this year and will be executed around the world in phases.

Each KeraSoft contact lens is custom made for the patient's exact needs, making it an ideal fit for manufacture and distribution through the B+L custom lab channel network. Traditionally, patients with irregular corneas have been limited to gas permeable lenses which resulted in reduced wear time for some patients. The companies state that KeraSoft lenses can increase wearing time for some of these patients.

KeraSoft lenses, which are recognized with the U.K.'s Queen's Award for Enterprise and Innovation, are a patented combination of the latest technologies in soft and silicone hydrogel materials using geometries from complex mathematics to offer comfortable wear and excellent vision, according to the companies.

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New Global Study Focuses on Patients' Vision Care Priorities

In a recent global study to determine the hierarchy of vision-corrected patient needs, seeing better was the most important consideration for selecting eye care products.

The Needs, Symptoms, Incidence, Global Eye Health Trends (NSIGHT) study surveyed 3,800 spectacle- and contact lens-corrected subjects, 15 to 65 years of age, from seven different countries (China, Korea, Japan, France, Italy, United Kingdom, United States). The current analysis aimed to determine a hierarchy of patient needs in the selection of eye-related products, based on respondents' scoring of 40 features representing eight categories of potential product features.

The eight categories of eye care product benefits, in descending order of importance to patients, were vision, health, environment, eye condition, convenience, comfort, personal performance and personal appearance.

The study, commissioned by Bausch + Lomb, was conducted by an independent market research firm, Market Probe: Europe. Additional analyses and reports from the exhaustive data obtained in NSIGHT are expected to appear in optometry journals and professional congresses throughout 2011.

AllAboutVision.com Launches Free Eye Health News Feed for Eyecare Practices' Facebook Pages

Educating patients about eye health topics can be easier with a newly launched news feed from AllAboutVision.com. Eye care practitioners can use the feed to automatically post breaking eye care news to their Facebook page.

Each week the news feed will feature two or three patient-friendly news items on eye health topics as they are added to AllAboutVision.com. The feed will not include any product news, and each item will link to the full story on the site.

Practices with Facebook pages can set up automatic wall postings from the feed through Facebook applications. This means practices can deliver interesting news to their patients on a continual basis without any effort or cost.

Detailed instructions are available for adding the Eye Health News Feed to a Facebook page, or an AllAboutVision.com staff member can add the feed at no cost to the practice. For details, and to see a feed-enabled example Facebook page, visit http://www.allaboutvision.com/ecp/.

Allergan Introduces Lastacaft for Patients with Allergic Conjunctivitis

Allergan is launching Lastacaft (alcaftadine ophthalmic solution) 0.25%, which is indicated for the prevention of ocular itching due to allergic conjunctivitis. The company states that alcaftadine, the active ingredient in Lastacaft, is a completely new chemical entity with an affinity for H1, a histamine receptor in the early phase of allergic conjunctivitis.

Lastacaft, a once-daily therapy for patients with allergic conjunctivitis, was shown to provide relief of ocular itching within three minutes in 97% of study participants (n=909), and one drop was shown to prevent ocular itching through 16 hours in 87% of study participants, according to the company.

Lastacaft is approved for use in pediatric patients over 2 years of age, as well as classified as category B for use in pregnant patients and will be available at the end of January.

GPLI Offers Free Live Webinars

The Gas Permeable Lens Institute (GPLI), in association with the Contact Lens Manufacturers Association, announces their schedule of live online webinars for the first half of 2011.

During these 90 minute educational programs contact lens fitters can communicate with industry experts. The sessions are held on the third Tuesday of every month 9 PM Eastern Time. The first hour of discussion is limited to the topic of month; however, attendees may ask any GP lens-related question during the remaining 30 minutes. All eye care professionals are invited to participate in these free programs

The topics and presenters scheduled through June are:
February 15 – GP Lens Care Update, Mr. Michael Ward
March 15 – GP Lens Management of Keratoconus, Dr. Bruce Anderson
April 19 – Myopia Control in 2011, Dr. Jeff Walline
May 17 – Management of the Irregular Cornea Patient, Dr. Greg DeNaeyer
June 21 – Problem Solving in Corneal Reshaping, Dr. Mike Lipson

For more information on these and other educational programs offered by the GPLI, visit www.gpli.info.

BCLA Launches Facebook Page

The British Contact Lens Association (BCLA) has launched a new Facebook page at 'BCLA 2011' to share all the very latest information about this year's Clinical Conference and Exhibition which is scheduled May 26-29 in Manchester.

This new initiative is also designed to develop an active online community between the Association, its members and others within the contact lens profession and industry.

Over the coming months the organization will be posting regular updates, photos and messages and invite all members and others within the profession and industry, including BCLA 2011 exhibitors and sponsors, to become fans and share their views on plans for BCLA 2011.

If you are already a Facebook member, simply search on 'BCLA 2011' to find the page and get started. .

If you have read our 2010 Annual Report on Dry Eye (click here), one of the things you will note is that it appears as though pharmaceutical treatment of dry eye disease (including contact lens dry eye) may be slightly on the rise. Indeed, it would be great to see new medications that would expand our horizons in treating dry eye disease in this regard. One interesting discussion that is brewing is the use of pharmaceuticals to treat contact lens related dry eye in otherwise normal contact lens wearers – those without pre-existing ocular surface disease. We'd like to get your thoughts on this topic. Thank you for responding to our Quick Poll below.

Researchers wanted to evaluate the capacity of neutrophils to enhance biofilm formation of an infectious PA corneal isolate on contact lenses. Agents which target F-actin and DNA were tested as a therapeutic strategy to disrupt biofilms formed in the setting of neutrophils in vitro and limit the infectious bioburden in vivo.

Biofilm formation by infectious PA strain 6294 was assessed in the presence of neutrophils in a static biofilm plate and on unworn etafilcon A soft contact lenses. A D-isomer of poly(aspartic acid) was used alone and with DNase to reduce biofilm formation on test contact lenses. Gentamicin survival assays were used to determine the effectiveness of the test compound in reducing subsequent intracellular bacterial load in the corneal epithelium in a rabbit contact lens infection model.

In a static reactor and on hydrogel lenses, PA biofilm density was enhanced 30-fold at 24 hours in the presence of neutrophils (p<0.0001). The combination of DNase and anionic poly(aspartic acid) reduced PA biofilms formed in the presence of activated neutrophils by 79.2% on hydrogel contact lenses (p<0.001). The identical treatment resulted in 41% reduction in internalized PA in the rabbit corneal epithelium after 24 hours (p=0.03).

Researchers concluded that these results demonstrate that PA can exploit the presence of neutrophils to facilitate early biofilm development on contact lenses. Incorporation of F-actin and DNA represent a mechanism for neutrophil-induced biofilm enhancement, as well as targets for available agents to disrupt pathogenic biofilms formed on contact lenses, and as a treatment for established corneal infections.

Robertson DM, Parks QM, Young RL, Kret J, Poch KR, Malcolm KC, et al. Disruption of contact lens-associated Pseudomonas aeruginosa biofilms formed in the presence of neutrophils. Invest Ophthalmol Vis Sci. 2011 Jan 18.